Department of Cardiac Surgery, An-Najah University Hospital, An-Najah National University, Nablus, P400, Palestinian Territories.
Faculty of Medicine, An-Najah National University, Nablus, Palestinian Territories.
J Cardiothorac Surg. 2024 Sep 12;19(1):527. doi: 10.1186/s13019-024-03004-2.
Coronary artery bypass grafting (CABG) surgery is a common procedure for managing multi-vessel coronary artery disease to revascularize the myocardium. Among the various conduits used, the left internal mammary artery (LIMA) is preferred due to its better long-term patency rate. However, CABG procedures involving LIMA may result in rare but serious complications, such as avulsion of the LIMA post-CABG, which leads to disruption of blood flow to the myocardium and the development of fatal cardiac tamponade.
We hereby present a unique case of spontaneous avulsion of a LIMA graft to the left anterior descending artery (LAD) away from the site of anastomosis, twenty-four hours following CABG surgery in a 67-year-old male patient. Emergency re-exploration and repair of the LIMA with interposition vein graft were performed and resulted in successful stabilization of the patient's critical condition. However, this was followed by a complicated recovery period involving atrial fibrillation, acute kidney injury, and wound infection.
Avulsion of LIMA graft following CABG is rare, yet a fatal complication that requires high clinical suspicion and prompt management. Avulsion has been reported a few times in literature following both minimal invasive and conventional CABG. Understanding the etiology, clinical presentation, and management of this complication is crucial to avoid catastrophic outcomes.
冠状动脉旁路移植术（CABG）是一种常见的治疗多支冠状动脉疾病以再血管化心肌的手术。在使用的各种移植物中，由于其更好的长期通畅率，左内乳动脉（LIMA）是首选。然而，涉及 LIMA 的 CABG 手术可能会导致罕见但严重的并发症，例如 CABG 术后 LIMA 的撕脱，这会导致流向心肌的血流中断，并发展为致命性心脏压塞。
我们在此介绍了一例独特的病例，一名 67 岁男性患者在 CABG 手术后 24 小时，LIMA 从吻合部位自发撕脱至左前降支（LAD）。紧急再次探查并修复 LIMA 并用静脉移植物间置，成功稳定了患者的危急状况。但随后出现了心房颤动、急性肾损伤和伤口感染等复杂的恢复期。
CABG 后 LIMA 移植物撕脱很少见，但却是一种致命的并发症，需要高度的临床怀疑和及时的处理。在微创和传统 CABG 后，文献中均有几次报道。了解这种并发症的病因、临床表现和处理方法对于避免灾难性结局至关重要。
